| NPI | 1487823654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QX0203X Clinic/Center, Oncology, Radiation (Licence: GA 65834) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: OH Training License) |
| Enumeration Date | 2008-02-21 |
| Last Update Date | 2012-11-07 |